Post-polio syndrome patients treated with intravenous immunoglobulin: a double-blinded randomized controlled pilot study

Post-polio syndrome (PPS) is characterized by new muscle weakness, atrophy, fatigue and pain developing several years after the acute polio. Some studies suggest an ongoing inflammation in the spinal cord in these patients. From this perspective, intravenous immunoglobulin (IvIg) could be a therapeutic option. We performed a double-blinded randomized controlled pilot study with 20 patients to investigate the possible clinical effects of IvIg in PPS. Twenty patients were randomized to either IvIg 2 g/kg body weight or placebo. Primary endpoints were changes in pain, fatigue and muscle strength 3 months after treatment. Surrogate endpoints were changes in cerebrospinal fluid (CSF) cytokine levels. Secondary endpoints were pain, fatigue and isometric muscle strength after 6 months. Patients receiving IvIg reported a significant improvement in pain during the first 3 months, but no change was noted for subjective fatigue and muscle strength. CSF levels of tumour necrosis factor- α (TNF- α ) were increased compared with patients with non-inflammatory neurological disorders. In conclusion, in this small pilot study no effect was seen with IvIg treatment on muscle strength and fatigue, however IvIg treated PPS patients reported significantly less pain 3 months after treatment. TNF- α was increased in the CSF from PPS patients. The results are promising, but not conclusive because of the low number of patients studied.     

Arterial and venous measurement in resting forearm of metabolic indicators during rest and leg exercise

We compared the levels of various metabolic indicators in arterial and venous forearm blood during maximal treadmill leg exercise, and the subsequent 9 min in nine volunteers aged 31-56 years. At maximal exercise plasma lactate was 13.2 +/- 3.1 mmol l-1 arterially, while venous was 41% lower, but increased more than arterial after exercise. There was a linear relationship between arterial and venous samples during and after exercise, but not at baseline. Plasma pyruvate increased on the arterial side from 49 +/- 8 to 172 +/- 30 mumol l-1 at maximal exercise, maximal venous was 21% lower. Free fatty acids were not different at rest, but decreased during exercise by 52 and 38% on the arterial and venous side. There was no relationship between arterial and venous levels. Changes in these three variables occurred significantly earlier on the arterial side. Arterial cyclic AMP rose from 97.3 +/- 28.4 to 262.7 +/- 67.5 nmol l-1 from rest to exercise, and was linearly inversely related to the decrease in free fatty acids. The mean venous pH was lower than arterial at rest, but was the same as arterial at maximal exercise and after. Thus, venous plasma lactate and pyruvate, but not free fatty acids, are linearly related to arterial measurements during maximal exercise, while pH is identical. Non-working muscle modifies exercise-induced changes, and therefore venous and arterial forearm blood sampling give more information than either alone.     

Neisseria meningitidis infections in Northern Norway: an epidemic in 1974-1975 due mainly to group B organisms.

A severe epidemic of disease due to Neisseria meningitidis has been occurring in northern Norway since 1974. Based on bacteriological and clinical examination of cases during the 18 months between January 1, 1974 and June 30, 1975, an overall attack rate of 26.3 cases per 100,000 population per year has been calculated. The attack rates were highest in 1975 (total, 37.4 cases per 100,000 population; Troms County, 54.5) and in children younger than four years (total, 173.6; Troms County, 328.9). The epidemic shows a total case-fatality ratio of 14.1%. The highest case fatality ratio was recorded for patients older than 20 years (25.0%). Among the youngest children, cases were distinctly more frequent in males than females; in older children and adults, male patients had a clearly higher case-fatility ratio than female patients. Of the three serogroups of N. meningitidis, group B caused more cases of infection that groups A and C together. In addition, the causative meningococcal strains were almost uniformly resistant to high concentrations of sulfonamide. Both of these traits appear to have developed in northern Norway at or shortly before the time when the epidemic began.     

The effect of human platelets on lipolytic activity in plasma.

A method for assay of lipolytic activity in platelet-poor plasma (PPP), platelet-rich plasma (PRP) and washed human platelets is presented. The lipolytic activity in PRP was about twice the activity in PPP. A significant correlation between lipolysis in platelets and platelet number was established. Molar sodium chloride strongly inhibited lipolytic activity in platelets and a washing procedure did not significantly change the lipolysis. The results indicate that a lipoprotein lipase is bound to human platelets and may play a role in metabolism of triglyceride in platelets.     

Psychiatric morbidity in stroke patients attending a neurology clinic in Nigeria

Back ground

Stroke produces a wide range of mental and emotional disorders. Neuropsychiatric complications associated with stroke may have negative effects on the social functioning, overall quality of life and the recovery of motor functioning of stroke survivors.

Objective

To determine the prevalence and nature of psychiatric morbidity among stroke patients attending neurology outpatient clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin-Nigeria.

Methods

All patients with stroke aged 18 years and above at an outpatient neurology clinic in Ilorin, Nigeria were assessed for mental and emotional disorders using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) over one year (March 2009 to February 2010).

Results

Overall prevalence of psychiatric morbidity was 36.0% (30/83) among 83 patients who constituted the study population. Specific diagnoses recorded were depression (19.2%), generalised anxiety disorder (9.6%), harmful alcohol use (2.4%); dementia, somatoform disorder, phobia and delusional disorder each had a prevalence of 1.2%. Clinical and sociodemographic variables were not significantly associated with psychiatric morbidity.

Conclusion

Psychiatric disorders are often associated with stroke. Identifying and treating stroke patients with these psychiatric co-morbidities could thus help to improve the overall quality of life of these patients.     

Better results with the new generation bare metal stents

During 15 cardiac surgery procedures including total bypass of variable duration (20-130 min) bioptic lung samples have been obtained in 3 successive phases of the operation (prior and after the bypass and before the final closure of the chest). Sections were examined at light and electron microscope. The findings show fatty microemboli in lung capillaries in samples obtained before the final closure of the chest in the medium duration ECC case and both, at the end of bypass and before the definitive closure of the chest in prolonged bypass. The entity of fatty microemboli appears linked to ECC duration.